EP 0870243 A4 19981209 - COMPUTER-IMPLEMENTED METHOD FOR PROFILING MEDICAL CLAIMS
Title (en)
COMPUTER-IMPLEMENTED METHOD FOR PROFILING MEDICAL CLAIMS
Title (de)
COMPUTERGESTÜTZTES VERFAHREN ZUM PROFILIEREN VON MEDISCHEN VERICHERUNGSANSPRÜCHEN
Title (fr)
PROCEDE INFORMATIQUE SERVANT A ETABLIR UN PROFIL DES RECLAMATIONS AU TITRE DE FRAIS MEDICAUX
Publication
Application
Priority
- US 9610787 W 19960624
- US 49372895 A 19950622
Abstract (en)
[origin: WO9701141A1] A computer-implemented method for profiling medical claims to assist health care managers in determining the cost-efficiency and service quality of health care providers. The method allows an objective means for measuring and quantifying health care services. An episode treatment group (ETG) is a patient classification unit which defines (64) groups that are clinically homogeneous (similar cause of illness and treatment) and statistically stable. The ETG grouper methodology uses service or segment level claim data as input data and assigns (62) each service to the appropriate episode. The program identifies concurrent and recurrent episodes, flags records, creates new groupings, shifts groupings for changed conditions, selects the most recent claims, resets windows, makes a determination if the provider is an independent lab and continues to collect information until an absence of treatment is detected.
IPC 1-7
IPC 8 full level
G06F 19/00 (2011.01); G06Q 10/08 (2012.01); G06Q 30/02 (2012.01); G06Q 40/00 (2006.01); G06Q 50/22 (2012.01); G06Q 50/24 (2012.01); G16H 10/60 (2018.01)
CPC (source: EP US)
G06Q 10/087 (2013.01 - EP US); G06Q 30/02 (2013.01 - EP US); G06Q 40/02 (2013.01 - EP US); G06Q 40/08 (2013.01 - EP US); G16H 40/67 (2017.12 - EP US); G16H 70/40 (2017.12 - EP US)
Citation (search report)
- No further relevant documents disclosed
- See references of WO 9701141A1
Designated contracting state (EPC)
AT BE CH DE DK ES FI FR GB GR IE IT LI LU MC NL PT SE
DOCDB simple family (publication)
WO 9701141 A1 19970109; AU 6392296 A 19970122; EP 0870243 A1 19981014; EP 0870243 A4 19981209; US 2002165738 A1 20021107; US 2002173987 A1 20021121; US 2002173988 A1 20021121; US 2002173989 A1 20021121; US 2002173992 A1 20021121; US 2007021988 A1 20070125; US 2008021742 A1 20080124; US 2008059231 A1 20080306; US 2008065421 A1 20080313; US 2008097788 A1 20080424; US 2010235197 A1 20100916; US 2010324928 A1 20101223; US 2011320219 A1 20111229; US 2013006672 A1 20130103; US 5835897 A 19981110; US 5835897 C1 20020219; US 6370511 B1 20020409; US 7620560 B2 20091117; US 7725333 B2 20100525; US 7774216 B2 20100810; US 7979290 B2 20110712; US 8121869 B2 20120221; US 8296165 B2 20121023; US 8700433 B2 20140415
DOCDB simple family (application)
US 9610787 W 19960624; AU 6392296 A 19960624; EP 96923406 A 19960624; US 10628102 A 20020325; US 10628202 A 20020325; US 10628402 A 20020325; US 10640902 A 20020325; US 10662602 A 20020325; US 18898698 A 19981109; US 201113181207 A 20110712; US 201213611350 A 20120912; US 49372895 A 19950622; US 50737706 A 20060821; US 76185507 A 20070612; US 78592710 A 20100524; US 84143907 A 20070820; US 85297810 A 20100809; US 85574607 A 20070914; US 86738607 A 20071004